Healthcare Provider Details

I. General information

NPI: 1811351497
Provider Name (Legal Business Name): DENISE CAMPBELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 DEERFIELD DR
PETERSBURG VA
23805-2507
US

IV. Provider business mailing address

325 DEERFIELD DR
PETERSBURG VA
23805-2507
US

V. Phone/Fax

Practice location:
  • Phone: 804-691-4765
  • Fax:
Mailing address:
  • Phone: 804-691-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001209905
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0001209905
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001209905
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number0001209905
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number0001209905
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number0001209905
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number0001209905
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number0001209905
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number0001209905
License Number StateVA
# 10
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number0001209905
License Number StateVA
# 11
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number0001209905
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: